Early positive technetium-99m stannous pyrophosphate images as a marker of reperfusion after thrombolytic therapy for acute myocardial infarction.
Early positive technetium-99m stannous pyrophosphate images as a marker of reperfusion after thrombolytic therapy for acute myocardial infarction.
复制标题
早期阳性 Technetium-99m 焦磷酸亚锡图像作为急性心肌梗死溶栓治疗后再灌注的标志。
DOI：
10.1016/0002-9149(85)90844-6
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
Willerson,JT
中科院分区：
文献类型：
--
作者：
Wheelan,K;Wolfe,C;Corbett,J;Rude,RE;Winniford,M;Parkey,RW;Buja,LM;Willerson,JT
14例经壁急性心肌梗死（AMI）患者在胸痛后平均4±1小时静脉注射链激酶治疗，并在胸痛后7±2小时行锝-99m焦磷酸亚锡（Tc-99m-PPi）显像。获得早期Tc-99m-PPi图像，以检验早期、强烈异常的Tc-99m-PPi图像提示再灌注的假设。14例患者中有11例在平均11±3小时出现血清肌酸激酶同工酶（CK-B）水平的早期峰值（16小时内）。14例患者中有10例急性Tc-99m-PPi为3+或4+。11例患者中有8例在AMI后15天心导管插管时梗死相关血管未闭。一名早期Tc-99m-PPi图像和CK-B峰值水平均为阳性的患者在插管时出现梗死相关动脉闭塞。10例急性Tc-99m-PPi强阳性患者的急性左室射血分数（EF）与LVEF在第15天比较，从0.37±0.13提高到0.50±0.16 （p = 0.004）。11例早期血清CK-B峰值患者的LVEF由0.37±0.12改善至0.49±0.15 （p = 0.003）。3例无再灌注证据的患者LVEF未能从初始值提高到出院时的LVEF。6例对照患者胸痛后10±2小时出现急性Tc-99m-PPi图像；急性期Tc-99m-PPi无强阳性，CK-B峰平均时间为19±5小时。在预测接受静脉链激酶治疗的AMI患者再灌注成功方面，早期Tc-99m-PPi阳性可能与早期CK-B峰值一样可靠。
Fourteen patients with transmural acute myocardial infarction (AMI) were treated with intravenous streptokinase a mean of 4 ± 1 hours after chest pain and underwent technetium-99m stannous pyrophosphate (Tc-99m-PPi) imaging 7 ± 2 hours after the onset of chest pain. The early Tc-99m-PPi images were obtained to test the hypothesis that an early, strongly abnormal Tc-99m-PPi image suggests reperfusion. Eleven of 14 patients had early peaking (within 16 hours) serum creatine kinase isoenzyme levels (CK-B) at a mean of 11 ± 3 hours. Ten of 14 patients had 3+ or 4+ acute Tc-99m-PPi images. Eight of 11 patients had patent infarct-related vessels at cardiac catheterization 15 days after AMI. One patient who had both an early positive Tc-99m-PPi image and CK-B peak level had an occluded infarct-related artery at catheterization. Acute left ventricular (LV) ejection fraction (EF) by radionuclide ventriculography was compared with LVEF on day 15, and improved from 0.37 ± 0.13 to 0.50 ± 0.16 (p = 0.004) in the 10 patients with strongly positive acute Tc-99m-PPi images. LVEF also improved from 0.37 ± 0.12 to 0.49 ± 0.15 (p = 0.003) in the 11 patients with early peaking serum CK-B values. Three patients without evidence of reperfusion failed to improve the LVEF from the initial value to the one obtained at hospital discharge. Six control patients had acute Tc-99m-PPi images 10 ± 2 hours after chest pain; none had strongly positive acute Tc-99m-PPi images, and the mean time to peak CK-B was 19 ± 5 hours. Strongly positive early Tc-99m-PPi images may be as reliable as early peaking CK-B in predicting successful reperfusion in patients receiving intravenous streptokinase therapy for AMI.